Upload
bal-raj
View
13
Download
3
Embed Size (px)
Citation preview
PONDICHERRY INSTITUTE OF MEDICAL SCIENCES
(A UNIT OF MADRAS MEDICAL MISSION) KALAPET, PUDUCHERRY
DEPARTMENT OF COMMUNITY MEDICINE
INTERNS RURAL POSTING(STUDY PERIOD 1/2/2014-28/2/2014)-CHUNAMPET
TITLE: “DETERMINANTS AND KNOWLEDGE ON CONTRACEPTIVE USAE AMONG WOMEN OF REPRODUCTIVE AGE GROUP IN A RURAL
AREA OF KANCHEEPURAM DISTRICT, TAMIL NADU”
INVESTIGATORS:
 
Prof.Dr.(Brig)Zile Singh Dr.Venkatachalam.J
HOD Assisstant Professor
PG IN CHARGE: Dr.Vishnu Prasad, 2nd year Post Graduate
INTERNS:
Dr.Abilash
Dr.Anantha Vigneshwari
Dr.Anisha Raymond
Dr.Antony Rosario
Dr.Balraj
Dr.Nirmal Krishna
Dr.Raghuram
Dr.Umar Basha
Dr.Vutla Kavya
ACKNOWLEDGMENTS
We’d like to take this opportunity to express our heartfelt
gratitude to the Head of Department of Community Medicine, Dr.
(Brig) Zile Singh, who gave us his timely and sincere guidance in the
goings about of this project. We also thank our co-guide,
Dr.Venkatachalam.J, Assistant Professor of the Department of
Community Medicine, who was with us every step of the way with
advice and support to help us attain our objectives.
We also thank Dr. Vishnu Prasad, 2nd year Postgraduate
student of the Department of Community Medicine who supported
us in the completion of the project. We extend our thanks to
Dr.Arun.S and Dr.Gopinath, RMO, Chunampet and the support
staff at the Rural Health Center in Chunampet who helped us make
this project a success.
Finally, we are greatful to all the study participants for their
cooperation as well as for spending their valuable time in proving us
the necessary details for the purpose of our study.
S.NO PARTICULARS PAGE NO
1 INTRODUCTION
2 OBJECTIVES
3 REVIEW OF LITERATURE
4 MATERIALS AND METHODS
5 RESULTS
6 DISCUSSION
7 SUMMARY AND CONCLUSION
8 REFERENCES
9 ANNEXURE –I QUESTIONNAIRE
CONTENTS
INTRODUCTIONINTRODUCTION
Global contraceptive usage was 63.3% in 2010
which was 9% more than that in 1990. Also in the last
two decades the Unmet need for Family Planning
decreased from 15.4% to 12.3% worldwide. These
changes were seen in almost all regions of the world
except in regions where family planning coverage was
already high. However, different regions showed
different levels of changes.1 Although India was the
first nation to have an official National Family
Planning Programme in 1952, the target was on health
of the women rather than population control. Then
census of 1971 revealed an alarming population growth
which necessitated adoption of population control
strategies in India. NFHS-III 2005-06 (National Family
Health Survey) in India revealed, the contraceptive
prevalence rate was 56% while in the past decade it
was 48%. 2 Providing universal Family Planning
services is an important strategy to reduce maternal
morbidity and to control population growth. 10% of all
pregnancies are mistimed and 11% of all pregnancies
are unwanted in India.2 The number of unintended
pregnancies can be brought down
Brought down by proper utilization of family planning
services. Worldwide the unmet need for Family
Planning decreased during the past two decades, but
the number of women with unmet needs remained the
same due to population growth. In India female
sterilization is the most commonly preferred method of
contraception accounting for 76% of all methods, while
in Tamil Nadu it was 90%. But the usage of temporary
methods of contraception remains low, which is mostly
due to social stigma and cultural misbeliefs4-5, lack of
knowledge6-7 and concern about side effects.4,7-9
Women’s decision on use of contraceptive methods is
influenced by several social constraints and social
circumstances including family sex composition and
gender preference. Worldwide, when contraception is
used properly and effectively to avoid unwanted
pregnancy it can reduce maternal deaths to 25%-
35%.10,11 Thus this study aims at measuring the
prevalence of unmet needs of family planning and its
determinants in a rural area of Kancheepuram district,
Tamil Nadu, South India.
OBJECTIVES
AIM:
To study the prevalence of unmet needs of family planning and its
determinants
OBJECTIVES:
To measure the prevalence of unmet needs of family planning
To study the determinants of contraceptive usage
REVIEW
OF
LITERATUREREVIEW OF LITERATURE:
The time since family planning services stared getting attention,
there has been many studies in the past on prevalence, acceptance and
usage of various contraceptive methods. It was during the late 20th
century contraceptive usage has gained momentum. However in many
developing countries the unmet needs for family planning still remained
considerably high, which is mostly due to lack knowledge, lack of
access and social stigma. There have been a few studies in the past
which attempted to estimate the contraceptive prevalence and pattern of
contraceptive usage.
Unmet Needs of family planning:
Varying levels of unmet needs of family planning have been
reported from different regions of the country. National Family Health
Survey (NFHS) reported the prevalence of unmet need for family
planning as 13% during the year 2005-06 while it was 16% during 1998-
99 in India. 2,12 Though in Tamil Nadu the unmet need was much less,
that is 9% during the year 2005-06, which reduced from 13% in the year
1998-99.13
In a study by Ilene S et al done in 6 cities of Uttar Pradesh, the most
populous state of India showed a varying prevalence of unmet need for
family planning from 12% in Moradabad to a maximum of 20% in
Aligarh. In Allahabad and Moradabad more percentage of women in the
slum have an unmet need for
family planning when compared to non-slum people. Also the unmet
need for limiting was more when compared to spacing .14
Yadav K et al in a study observed that prevalence of unmet needs
of family planning in Haryana to be 17.5% for married women, and also
unmet need was significantly higher among married women when
compared to men.15
A study done in Kancheepuram district by Prateek SS et al
revealed that the unmet need for contraception was 51.6% among
women of reproductive age group (15-49) years attending general
outpatient department in Urban Health Center.16
Contraceptive usage pattern and its prevalence:
Female sterilization remains the most preferred method of
contraception among married women, which accounted for 87% of
contraceptive use during 1998-99 and it became 90% during 2005-06 in
NFHS III in Tamil Nadu. But nationally female sterilization accounted
for 71% of all contraceptive use in NFHS II and 66% in NFHS III. 77%
of the female sterilization operations were acquired from Government
facilities in Tamil Nadu, however nation-wide it was 84%.2,12,13
In a study done by Srividhya V et al in Bangalore, 73.9% of the
study participants have not used any method of contraception before
sterilization.
while 15.8% of the study subjects used IUD, the commonest method of
contraception used for spacing.17
Patro BK in a study in Delhi observed that nearly 74% of the
women already
had 2 children when they first used a contraceptive method and 21%
used a contraceptive method for the first time after first child birth. Also
most of the study subjects used contraception to limit the family size
than for spacing. Only 2% of them used contraception before the first
child was born.18
Sharma V et al in a study done in Lucknow found that 47% of
women in rural area haven’t used any family planning method in the
past.19
68% of the married woman in a Mumbai slum are currently using a
contraceptive method as observed by Makade KG et al in their study.
The study results also show that 28% of them are using Oral
Contraceptive Pills followed Condoms (18%) and female sterilization
(11%). Although Copper-T was the most preferred method of
contraception it was used by only 9% of the married woman.20
Perceptions and Knowledge of Contraception:
Almost all women have knowledge about contraceptive methods in
India, females sterilization is the most known contraceptive method.
However the knowledge on temporary methods of contraception was
still considerably low.
61% of women have heard or seen a message about contraception in
media in the recent past, while this percentage was much higher among
males (92%).2 A study done in Lucknow by Sharma V et al indicates that
more than 90% women are aware of the male and female sterilization
methods, Condoms, IUCD (Intra-Uterine contraceptive devices) and
traditional methods of contraception. Health workers in rural area
and media in urban area remained as a major source of Information
about family planning to the women. 19
Makade KG et al in a study done in a Mumbai slum reported that
87% of the married woman are aware of Oral Contraceptive Pills and
Copper-T (Cu-T) and 80% of them are aware about female sterilization.
Decision on contraceptive usage is taken mutually by Husband and Wife
in in 41% of the cases and in 30% of the cases the decision was taken by
the husband. Nearly 85% of the study subjects are aware about the place
of availability of contraceptive services.20
MATERIALS
AND
METHODSMETHODOLOGY:
Study Setting: The Study was carried out in Chunampet panchayat, a
rural area in Kancheepuram District, Tamil Nadu, South India. Also the
field practice area of Rural Health Training Center, Pondicherry Institute
of Medical Sciences.
Study Design: Community Based Cross Sectional Study
Study Population: All women between 15-49 years of age in the study
area, who gave consent to participate are included in the study
Study Period: 1st Feb 2014 to 28th Feb 2014
Study Tool: Pretested Structured Questionnaire
Study Variables: Socio-Demographic profile, Personal details,
Knowledge about Contraceptives, Contraceptive usage pattern,
Perceptions on Family planning and family size were studied.
Sample Size: The required Sample Size was calculated to be 452, based
on the National prevalence of Unmet needs for family planning, 13%
from NFHS III2, with precision taken as 10%. Sample size was
calculated using the formula Z2PQ/d2
Sampling: Streets were selected randomly and all the households in the
street were included in the study. In every household all the available
and
eligible women were explained about the study and recruited. The study
was explained regarding the benefits and implications of study to all the
participant in their own language and their voluntary informed written
consent was sought before interviewing the participants.
Operational Definitions:
Unmet Need for Family Planning: The percent with an unmet need for
family planning is the number of women with unmet need for family
planning expressed as a percentage of women of reproductive age who
are married or in a union. Women with unmet need are those who are
fecund and sexually active but are not using any method of
contraception, and report not wanting any more children or wanting to
delay the birth of their next child.21
Statistical Analysis: MS Excel 2010 was used for data entry. Data
validation is MS excel was used to avoid errors in data entry. SPSS
Version 21 was used for statistical analysis.
RESULTS
RESULTS:
Figure 1. Education status of study respondants (n= 505)

Maximum (26%) of our study respondants completed high school followed by
middle school. 25% of the study population were illiterate.
Figure 3. Distribution of study respondants based on Religion (n= 505)
Most of the study participants were Hindus (97.4%), while Muslims and Christians
were
1% each.
Figure 4. Distribution of the study respondants base on the Marital status (n=
505)

Nearly 90% of our study participants are married, while 5% of them were widow
and 2% are separated.
Figure 5: Perception of the study subjects on Ideal age for marriage for
Women
(n = 505)

Nearly 70% of the study participants responded that 20-23 years is the ideal age for
a Girl to get married
Figure 6: Perception of the study participants about ideal no of children a couple can have (n=505)

Nearly 77% responded that ideal number of children a couple can have is 2 and 17% of the participants responded that ideal number of a children a couple
can have is 3.
Figure 8: Perception about spacing between two children can cause health problems (n=505)

About 45% responded that less spacing between two children can lead to health problems and 35% of our participants did not know that whether less spacing
between two children leads to health problems Figure 10: Pattern of Gender preference (n=505)

Only 29% of our participants prefers to have male child while 56% have no preference.
Figure 12: Insisted Gender (n=42)

Majority of our participants (80%) have been insisted to having a male child and the rest (20%) have been insisted to have a female child.
Figure 14: Contraceptive preference of our participants (n=427)

Approximately 81% of our respondents prefer to use sterilization as a
contraceptive method and 9% prefer to use Intrauterine contraceptive devices.
Figure 15: Knowledge about using contraceptive methods can prevent Sexually Transmitted Diseases (n=427)

Among those who have heard of a contraceptive method, about 22% of them responded that contraceptives can prevent STD
Figure 16: Knowledge about the contraceptive method that can prevent Sexually Transmitted Diseases (STD) (n=97)

Nearly 51% of the participants those who said STDs can be prevented by the use of
Contraceptive methods, responded that condoms can prevent STD.
Figure 17: Participants who have ever used a contraceptive measure
(n = 505)

Nearly 72% of the respondents have ever used atleast one form of contraceptive
method, whereas rest of the study participants have not used any contraceptive
method.
Figure 18: Source of information about contraceptive method (n=310)

Nearly half of the respondents have stated that the source of information about the
contraceptive methods was obtained through media and 29% of the respondents have gained knowledge about contraceptive methods from Doctors/ Nurses, the
rest from health worker, friends and relatives. Figure 19: Place from where the contraception facility was obtained (n=309)

Majority of our participants have obtained contraception from government
facilities.
Figure 20: Perception regarding failure of contraceptive measures (n=287)

Majority of our participants have never had a contraceptive failure while only a 2% had experienced contraceptive failure.
Figure 22: Decision regarding usage of contraception (n=309)
Majority of our study population have made their decision on contraceptive usage
mutually by both husband and wife, and 7.76% of the women made their own
decision regarding contraceptive usage.
Figure 23: Usage of contraceptive measure by partner (n=457)
In our study population, majority of participant’s partner did not use any form of contraceptive measures
Figure 25: Current usage of contraceptive measure (n=505)

Nearly half of our participants were currently using contraceptive measure and 48% of them were not using contraceptive measure now.
Figure 27: Prevalence of Unmet Needs of Family Planning among women of reproductive age group (15-49) years


Unmet need for Family Planning =
Women (Married or in an Union), who are not using contraception, are fecund, and desire to either stop childbearing and postpone their next birth for atleast 2 years + Pregnant women whose current pregnancy was unwanted or mistimed + women in postpartum amenorrhoea who are not using contraception and, at the time they became pregnant , had wanted to delay or prevent pregnancy___________________________________________
Total number of women of reproductive age (15-49) who are married or in an union
Figure 28: Unmet needs of family planning for spacing and limiting (n=135)

54% of the Unmet need was for Limiting and 45% of the Unmet need was for
Spacing.

The unmet need for family planning was more for individuals aged 15-25 years
when compared to older age groups and the difference was found to be
statistically significant. This shows the younger age group requires more emphasis
on family planning and adequate fertility control.
Table 1. Association
between current age
of the participant and Unmet
Need for Family
PlanningCurrent Age
of the Participant(in years)
Unmet Need for Family Planning
Total p - Value
Present (%) Absent (%)
15-25 55 (47.4%) 61 (52.6%) 116 (100%) p < 0.0001
26-35 48 (26.8%) 131 (73.2%) 179 (100%)
36-49 32 (22.9%) 108 (77.1%) 140 (100%)
Total 135 (31%) 300 (69%) 435 (100%)